Objective:To investigate the clinical efficacy of Intervertebral Differential Dynamics(IDD)combined with spinal assessment training system on the patients with lumbar disc herniation.Method:Sixty patients with L4—L5 or L5—S1 paramedian Lumbar Disc Herniation(LDH)were selected and randomly divided into a test group and a control group with 30 patients in each group through the random number table method.Both groups received health education.The control group was given IDD therapy once a day,5 times a week for a total of 4 weeks.The test group was given additional spinal assessment training sys-tem training on the basis of the control group;Spinal assessment training system training was conducted 3 times a week for a total of 4 weeks,12 units.The visual analog scale(VAS)was used to evaluate the severity of low back pain and leg pain.The ODI(Oswestry Disability Index)and the Japanese Orthopaedic Association(JOA)Low Back Pain Rating Scale were used to evaluate the lumbar dysfunction.Spinal assessment training system was used to measure the maximum angle and maximum muscle strength of lumbar flexion and dorsi-flexion.At the same time,the cross-sectional area of the lumbar multifidus muscle was measured by a color Doppler ultrasound diagnostic system before and after treatment.Result:Before treatment,there were no significant differences between the two groups in terms of VAS scores for low back pain and leg pain,ODI scores,JOA scores,maximum lumbar flexion and dorsiflexion,maximum muscle strength values,and cross-sectional area of multifidus muscle(P>0.05).After treatment,VAS scores for low back pain and leg pain,ODI,JOA,lumbar flexion and dorsiflexion range of motion,as well as the maximum muscle strength values for flexion and extension in the experimental group were better than those before treatment,and all indicators in the experimental group were better than those in the control group,with significant differences(P<0.05).Conclusion:IDD combined with spinal assessment training system can effectively relieve back and leg pain in patients with L4—L5 or L5—S1 paracenteral lumbar disc herniation,improve the degree of physical activity limitation,increase lumbar motion and muscle strength,and improve lumbar function.

Objective:To evaluate the analgesic effect of intercostal muscle plane block of external oblique muscle in patients undergoing endoscopic pancreaticoduodenectomy.Methods:A total of 48 patients undergoing endoscopic pancreaticoduodenectomy under elective general anesthesia in Nanjing First Hospital from February to July 2023 were prospectively selected and divided into two groups ( n=24) according to random number table method: abdominal external oblique intercostal muscle plane block combined with general anesthesia group (EG group) and general anesthesia group (G group). The EG group was blocked in the intercostal muscle plane of the external oblique muscle before general anesthesia induction, and 0.375% ropivacaine 20 ml was injected on both sides, respectively. Patient-controlled intravenous analgesia (PCIA) was performed in both groups after operation, and the pain Visual Analogue Scale (VAS) score was less than 4 points. When the VAS score was ≥4, 1 mg oxycodone was injected intravenously for relief and analgesia. VAS scores at 30 min (T 0), 6 h (T 1), 12 h(T 2), 24 h(T 3), 48 h(T 4) after extubation, intraoperative drug and fluid dosage, postoperative sleep quality, analgesic satisfaction score, remedial analgesia and the occurrence of adverse reactions were recorded. Results:The scores of rest and exercise VAS at T 0, T 1, T 2, T 3 and T 4 in the EG group were significantly lower than those in the G group (all P<0.05). The dosage of norepinephrine, propofol, remifentanil and total fluid infusion in the EG group were significantly lower than those in the G group (all P<0.05). The sleep quality and analgesic satisfaction of the EG group were better than those of the G group (all P<0.05), the first time of PCIA compression after surgery was longer than that of the G group ( P<0.05), the number of effective compressions, the amount of oxycodone relief and analgesia, the proportion of nausea and vomiting, and the stay time of anesthesia intensive care unit (AICU) were lower than those of the G group (all P<0.05). There was no significant difference in total hospital stay between the two groups ( P>0.05). Conclusions:Compared with general anesthesia alone, abdominal external oblique intercostal muscle plane block combined with general anesthesia in patients with endoscopic pancreaticoduodenectomy has significant postoperative analgesia effect, which can not only reduce postoperative VAS score and opioid consumption, but also improve sleep quality and increase postoperative analgesia satisfaction. Ultrasound-guided intercostal muscle plane block of external oblique muscle can be used as a better analgesic method in endoscopic pancreaticoduodenectomy.

Objective:To investigate the clinical efficacy of Intervertebral Differential Dynamics(IDD)combined with spinal assessment training system on the patients with lumbar disc herniation.Method:Sixty patients with L4—L5 or L5—S1 paramedian Lumbar Disc Herniation(LDH)were selected and randomly divided into a test group and a control group with 30 patients in each group through the random number table method.Both groups received health education.The control group was given IDD therapy once a day,5 times a week for a total of 4 weeks.The test group was given additional spinal assessment training sys-tem training on the basis of the control group;Spinal assessment training system training was conducted 3 times a week for a total of 4 weeks,12 units.The visual analog scale(VAS)was used to evaluate the severity of low back pain and leg pain.The ODI(Oswestry Disability Index)and the Japanese Orthopaedic Association(JOA)Low Back Pain Rating Scale were used to evaluate the lumbar dysfunction.Spinal assessment training system was used to measure the maximum angle and maximum muscle strength of lumbar flexion and dorsi-flexion.At the same time,the cross-sectional area of the lumbar multifidus muscle was measured by a color Doppler ultrasound diagnostic system before and after treatment.Result:Before treatment,there were no significant differences between the two groups in terms of VAS scores for low back pain and leg pain,ODI scores,JOA scores,maximum lumbar flexion and dorsiflexion,maximum muscle strength values,and cross-sectional area of multifidus muscle(P>0.05).After treatment,VAS scores for low back pain and leg pain,ODI,JOA,lumbar flexion and dorsiflexion range of motion,as well as the maximum muscle strength values for flexion and extension in the experimental group were better than those before treatment,and all indicators in the experimental group were better than those in the control group,with significant differences(P<0.05).Conclusion:IDD combined with spinal assessment training system can effectively relieve back and leg pain in patients with L4—L5 or L5—S1 paracenteral lumbar disc herniation,improve the degree of physical activity limitation,increase lumbar motion and muscle strength,and improve lumbar function.

OBJECTIVES: To analyze bone mass distribution and the factors affecting bone mass in a general Chinese Han cohort undergoing physical examinations at our center. METHODS: We retrospectively collected the data of bone mineral density (BMD) measurements from 30 599 healthy Han Chinese adults (age≥20 years) who underwent dual-energy X-ray absorptiometry scans at our hospital from July, 2013 to July, 2023. Basic parameters including height, body weight, and gender were recorded, and descriptive statistics and correlation analyses were performed using R software. RESULTS: In this cohort, the male individuals had a mean peak BMD of 1.00±0.12 g/cm² in the lumbar vertebrae, 0.94±0.14 g/cm² in the femoral neck, and 0.99±0.13 g/cm² in the total hip, significantly higher than the values in the female individuals [0.99±0.12 g/cm² in the lumbar vertebrae (P=0.022), 0.79±0.11 g/cm² in the femoral neck (P<0.001), and 0.88±0.11 g/cm² in the total hip (P<0.001)]. In the overall cohort, the BMD values of the lumbar spine and femur decreased with age after reaching their peak levels. There was a positive correlation between BMD value and body mass index (BMI) in both male and female individuals. The 2013-2014 period recorded the lowest BMD values in the lumbar, hip, and femoral neck, which tended to increase steadily in the following years (2015-2023). CONCLUSIONS Our data suggest that the BMD values vary among different populations, and future multi-center studies using more accurate BMD detection technology are warranted to capture the variation patterns of BMD with demographic characteristics of specific populations.
Humans ; Bone Density ; Absorptiometry, Photon ; Male ; Female ; Retrospective Studies ; Osteoporosis/diagnostic imaging* ; Adult ; Middle Aged ; Lumbar Vertebrae/diagnostic imaging* ; China/epidemiology* ; Femur Neck/diagnostic imaging* ; Aged ; Beijing/epidemiology* ; Young Adult

Objective:To investigate the effect of an integrated orthopedic rehabilitation model on pain,ankle function and exercise level over 24 weeks after lateral ankle ligament repair.Method:A retrospective cohort of 81 patients after ankle ligament repair at the fourth medical center of Chinese PLA general hospital from September,2021 to September,2022 were selected.The patients were divided into an experimental cohort(n=43)and a control cohort(n=38)by whether the patient had received integrated orthopaedic rehabilitation(strictly follow clinical pathway of rehabilitation for postoperative ankle ligament repair patients)or conventional physician-guided rehabilitation.American orthopedic foot and ankle society score(AOFAS)、visual analogue scale(VAS)、foot and ankle ability measure-activities of daily living(FAAM-ADL)、foot and ankle ability measure-sport(FAAM-S)and Tegner score were assessed at 2 weeks、12 weeks、24 weeks after surgery.Result:The AOFAS、VAS score was statistically higher in experimental cohort than in control cohort at 12 weeks after surgery(P=0.043、P=0.033).The AOFAS、FAAM-ADL、Tegner score(P=0.017、P=0.021、P=0.038,re-spectively)was higher and VAS score(P=0.035)was lower in the experimental cohort than in control cohort at 24 weeks.Conclusion:Integrated orthopaedic rehabilitation can improve ankle function,exercise level and quality of life on patients after ankle ligament repair surgery compared with conventional rehabilitation.

Objective:To investigate the effect of an integrated orthopedic rehabilitation model on pain,ankle function and exercise level over 24 weeks after lateral ankle ligament repair.Method:A retrospective cohort of 81 patients after ankle ligament repair at the fourth medical center of Chinese PLA general hospital from September,2021 to September,2022 were selected.The patients were divided into an experimental cohort(n=43)and a control cohort(n=38)by whether the patient had received integrated orthopaedic rehabilitation(strictly follow clinical pathway of rehabilitation for postoperative ankle ligament repair patients)or conventional physician-guided rehabilitation.American orthopedic foot and ankle society score(AOFAS)、visual analogue scale(VAS)、foot and ankle ability measure-activities of daily living(FAAM-ADL)、foot and ankle ability measure-sport(FAAM-S)and Tegner score were assessed at 2 weeks、12 weeks、24 weeks after surgery.Result:The AOFAS、VAS score was statistically higher in experimental cohort than in control cohort at 12 weeks after surgery(P=0.043、P=0.033).The AOFAS、FAAM-ADL、Tegner score(P=0.017、P=0.021、P=0.038,re-spectively)was higher and VAS score(P=0.035)was lower in the experimental cohort than in control cohort at 24 weeks.Conclusion:Integrated orthopaedic rehabilitation can improve ankle function,exercise level and quality of life on patients after ankle ligament repair surgery compared with conventional rehabilitation.

Objective:To evaluate the analgesic effect of intercostal muscle plane block of external oblique muscle in patients undergoing endoscopic pancreaticoduodenectomy.Methods:A total of 48 patients undergoing endoscopic pancreaticoduodenectomy under elective general anesthesia in Nanjing First Hospital from February to July 2023 were prospectively selected and divided into two groups ( n=24) according to random number table method: abdominal external oblique intercostal muscle plane block combined with general anesthesia group (EG group) and general anesthesia group (G group). The EG group was blocked in the intercostal muscle plane of the external oblique muscle before general anesthesia induction, and 0.375% ropivacaine 20 ml was injected on both sides, respectively. Patient-controlled intravenous analgesia (PCIA) was performed in both groups after operation, and the pain Visual Analogue Scale (VAS) score was less than 4 points. When the VAS score was ≥4, 1 mg oxycodone was injected intravenously for relief and analgesia. VAS scores at 30 min (T 0), 6 h (T 1), 12 h(T 2), 24 h(T 3), 48 h(T 4) after extubation, intraoperative drug and fluid dosage, postoperative sleep quality, analgesic satisfaction score, remedial analgesia and the occurrence of adverse reactions were recorded. Results:The scores of rest and exercise VAS at T 0, T 1, T 2, T 3 and T 4 in the EG group were significantly lower than those in the G group (all P<0.05). The dosage of norepinephrine, propofol, remifentanil and total fluid infusion in the EG group were significantly lower than those in the G group (all P<0.05). The sleep quality and analgesic satisfaction of the EG group were better than those of the G group (all P<0.05), the first time of PCIA compression after surgery was longer than that of the G group ( P<0.05), the number of effective compressions, the amount of oxycodone relief and analgesia, the proportion of nausea and vomiting, and the stay time of anesthesia intensive care unit (AICU) were lower than those of the G group (all P<0.05). There was no significant difference in total hospital stay between the two groups ( P>0.05). Conclusions:Compared with general anesthesia alone, abdominal external oblique intercostal muscle plane block combined with general anesthesia in patients with endoscopic pancreaticoduodenectomy has significant postoperative analgesia effect, which can not only reduce postoperative VAS score and opioid consumption, but also improve sleep quality and increase postoperative analgesia satisfaction. Ultrasound-guided intercostal muscle plane block of external oblique muscle can be used as a better analgesic method in endoscopic pancreaticoduodenectomy.

Objectives:To explore the influencing factors of daily living abilities in patients with traumatic spinal cord injury.Methods:A cross-sectional study was conducted on 148 patients with traumatic spinal cord injury admitted to our hospital from January 2019 to January 2023.Factors that may affect the daily living abilities of patients were collected,including gender,age,marital status,course of injury,cause of in-jury,level of injury,American Spinal Injury Association(ASIA)impairment scale(AIS),surgical situation and urination pattern.The spinal cord independence measure Ⅲ(SCIM-Ⅲ)was used to evaluate the daily living abilities in patients with traumatic spinal cord injury.The relationship between the influencing factors and daily living abilities was analyzed by single factor analysis,and multiple linear regression was applied to ana-lyze the impact of the influencing factors on daily living abilities.Results:Univariate analysis showed that the level of injury,AIS and,the urination pattern had significant effects on daily living abilities(P＜0.05),while gender,age,marital status,course of injury,cause of injury,surgical situation had no significant effects on daily living abilities.With regard to the level of injury,patients with sacral spinal cord injury had the best daily living abilities,and patients with cervical spinal cord injury were the worst in daily living abilities.Regarding AIS,patients of level A were the worst in daily living abilities,and patients of level E were the best.In terms of urination pattern,patients who could spontaneous voiding were the best in daily living abil-ities,while those with indwelling catheter/bag had the worst daily living abilities.There were statistically significant differences in self-care,respiratory and sphincter management,movement and total scores between patients with different injury levels,urination patterns and AIS(P＜0.01).Multiple linear regression showed that injury level,urination pattern and AIS were the main factors affecting the daily living abilities.Conclusions:The level of injury,AIS,and the urination pattern are the main factors affecting the daily living abilities of patients with traumatic spinal cord injury,and patients with injury of cervical cord,AIS level A,and indwelling catheter/bag have poor daily living abilities.

Objective:In order to explore the impact of corona virus disease 2019(COVID-19)on the hospitalization of children with bronchiolitis and to improve clinicians′ understanding of the characteristics of bronchiolitis during the COVID-19 epidemic.Methods:This was a multicenter clinical study, and the data have been collected from 23 children′s medical centers in China.All the clinical data were retrospectively collected from children with bronchiolitis who were hospitalized at each study center from January 1, 2019 to December 31, 2021.The results included gender, age at hospitalization, length of stay, respiratory syncytial virus(RSV) test results, severity rating, ICU treatment, and the total number of children hospitalized with respiratory tract infection during the same period.The clinical data of children with bronchiolitis in 2019 before COVID-19 epidemic and in 2020、2021 during COVID-19 epidemic were statistically analyzed and compared.Results:According to a summary of data provided by 23 children′s medical centers, there were 4 909 cases of bronchiolitis in 2019, 2 654 cases in 2020, and 3 500 cases in 2021.Compared with 2019, the number of bronchiolitis cases decreased by 45.94% in 2020 and 28.70% in 2021.In 2019, 2020 and 2021, there were no significant differences in gender ratio, age, and duration of hospitalization.Compared with 2019, the ratio of bronchiolitis to the total number of hospitalizations for respiratory tract infection decreased significantly in 2020 and 2021( χ2=12.762, P<0.05; χ2=84.845, P<0.05).The proportion of moderate to severe bronchiolitis cases in both 2020 and 2021 was lower than that in 2019, and the difference was statistically significant ( χ2=4.054, P<0.05; χ2=8.109, P<0.05).There was no statistically significant difference in the proportion of bronchiolitis cases requiring ICU treatment between 2019, 2020, and 2021 ( χ2=1.914, P>0.05).In 2019, a total of 52.60%(2 582/4 909) of children with bronchiolitis underwent RSV pathogen testing, and among them, there were 708 cases with RSV positive, accounting for 28.00%.In 2020, 54.14%(1 437/2 654) of children with bronchiolitis underwent RSV pathogen testing, and there were 403 cases with RSV positive, accounting for 28.04%.In 2021, 66.80%(2 238/3 500) of children with bronchiolitis underwent RSV pathogen testing, and there were 935 cases with RSV positive, accounting for 41.78%.Compared with 2019 and 2020, the RSV positive rate in 2021 showed a significant increase( χ2=99.673, P<0.05; χ2=71.292, P<0.05). Conclusion:During the COVID-19 epidemic, the implementation of epidemic prevention and control measures reduced the hospitalization rate and severity of bronchiolitis, but did not reduce the positive rate of RSV detection.

Objective:To investigate the relationship and intrinsic mechanism between disease uncertainty, coping style, social support and caregiver burden of primary caregivers of stroke, in order to provide a theoretical basis for reducing the burden of care and improving the quality of care for stroke caregivers.Methods:In this study, the main caregivers of 314 stroke patients hospitalized in Xinjiang Uygur Autonomous Region People's Hospital from December 2021 to May 2022 were selected by convenience sampling method, and cross-sectional surveys were conducted using the general data questionnaire, the Family Scale of Disease Uncertainty, the Simple Coping Style Questionnaire, the Social Support Rating Scale, and the Caregiver Burden Scale. Model 4 in Hayes′ SPSS-Process program was used to test the mediation effect, and Model 15 was used to test the mediation effect of social support.Results:The positive predictive effect of disease uncertainty in the primary caregiver of stroke patients on the burden of caregivers was significant ( β=0.665, P<0.01). Active coping played a partial mediating role between disease uncertainty and caregiver burden, with a mediating effect of 0.306 and a mediating effect of 31.8%. The interaction between disease uncertainty and social support had a significant predictive effect on caregiver burden ( β=-0.033, P<0.05), and the interaction item between active response and social support had a significant predictive effect on caregiver burden ( β=-0.019, P<0.05). Conclusions:Positive coping is an important psychological mechanism between disease uncertainty and caregiver burden, and social support can alleviate the influence of disease uncertainty on caregiver′s burden, and can also strengthen the weakening effect of positive coping on caregiver′s burden.